Being a neurologist is kind of like being a really really smart birthday clown. You get people to do a bunch of crazy things, and you have this whole absurd bag of tricks to get them to do it. For example, I can do all kinds of things to test the function of the right side of your brain if I suspected a stroke. I could have you draw a clock, or squiggly lines, look for motor or sensory defects. If I was looking at your left side maybe I would have you repeat complex phrases, or tell me what things are in a room, or perhaps even sing row row row your boat. Then there is of course a whole plethora of tests that involve pushing, pulling, pinching, jumping, skipping, circling, and kayaking to look at other functions. The good neurologist can take the results of all of these tests, lay them on a road map of the brain, and put a pin where the lesion is.
The cool thing to me is that most things in Neurology you can see and feel. You can always feel weakness, you can see a facial droop, or hear slurred speech. This is not like looking at someone’s belly and pondering what their pancreas is doing to their calcium.
After the first week on Neuro I was starting to get a feel for how it was going to be. I would show up at about 8am, the resident comes in and gives Kim and I a patient each, we see the patient, do a write up, and present our findings to the attending at 10am. In case your getting lost the breakdown of the hospital power struggle is as follows: Attending physician on top- Chief resident- resident- intern(first year resident)- “Sub I” (fourth year med student doing a one time sub-internship)- Fourth year med student- and of course the desolate third year med student.
After we present our cases to the attending we go as a team and see the patients again. There are about 7 people on our team, so when we walk down the hall it’s kind of like this neurology gang. I have day dreams that maybe someday the Cardiology team will impinge on our turf, and there will be some musical rendition of west side story, and we all pull out switch blades to battle for the primary care of the little old lady with a stroke.
I keep wondering what must be going through the patients head when the attending comes in followed by six other doctors. Do they think “Shit” I must be really sick! Or, wow look at the great care I’m getting. If I was the patient I think I would lean more toward the former. So the theory for the medical student in this environment is to watch and learn, ask very selective questions, and be ready to be pimped (the word used in the medical arena for rapid fire questioning).
The reality most of the time is, be really bored and stand against the wall, ask questions that they don’t want to answer, and pray that you will be pimped to break the boredom of doing nothing. This pattern of course depends on who the attending is, and what their style is, and we have had some good and some bad. The first one we had was great, she interacted with us, taught us things, and let us go home if she didn’t think it was worth our time. The second one would drag us around all day, not talk to us, and take forever doing anything. So it’s a crap shoot. I have quickly come to realize the word standardization has no bearing in the clinical years of med school.
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